Evaluation of Create-Your-Own-Adventure Activities on Student Knowledge and Critical Thinking Skills in Second-Year Student Pharmacists

Purpose: Create-your-own-adventure (CYOA) activities are educational innovations where students choose the "best pathway” of treatment. Current literature suggests increased student perception of knowledge and critical thinking skills with use of CYOA activities; however, evidence that such skills ultimately improve is lacking. The primary objective of this study is to assess changes in knowledge and critical thinking after completing a CYOA activity. Methods: Seventy-five second-year pharmacy students completed a CYOA activity on venous thromboembolism, with a six-question quiz immediately before and after. Questions were mapped to pre-set learning objectives with slight alterations to questions on each assessment. Four questions were then mapped to the final exam which occurred approximately three weeks after the activity. Friedman’s two-way analysis and Cochran’s Q test were used to evaluate differences in scores. Descriptive statistics were used to describe student perceptions and scores on a modified Need for Cognition scale. Results: There was a significant decrease in mean scores for each assessment (68.1% vs. 64.9%, vs. 40.0%; p<0.001). Similar results were found when stratifying scores by question. Of the 48 survey responses, 94% preferred the CYOA activity and perceived increased critical thinking skills. All Need for Cognition items scored >3.5, indicating satisfaction in critical thinking. Conclusions: Although we hypothesized an increase in scores with use of CYOA activities, there was a negative association between the activity and scores. Possible limitations include mapped questions that were too dissimilar, VTE management being too multivariate, and lower student retention of cumulative material on finals. These limitations will be addressed in future CYOA activities.